Virginia Democratic gubernatorial hopeful Ralph Northam has grabbed attention by repeatedly calling President Trump a “narcissistic maniac” at campaign events, and in a TV ad airing statewide and in the metropolitan region, which includes the White House.

“We want to be medically correct,” Northam, a pediatric neurologist, recently quipped on WAMU’s “Kojo Nnamdi Show” when asked about his use of the term.

In the ad, “Listening,” Northam speaks in his laconic Virginia drawl about the importance of listening as a doctor and in his current position as lieutenant governor. Then he looks at the camera and calmly says, “I’m listening carefully to Donald Trump, and I think he’s a narcissistic maniac.”

By suggesting the unpredictable and braggadocios president has a narcissistic personality disorder, Northam is not only startling TV viewers, he is crossing into a heated debate within the medical profession about whether it is appropriate to speculate about the health of public figures.

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It was an especially hot topic during the 2016 election cycle, when many were questioning both Hillary Clinton’s physical well-being and Donald Trump’s mental health.

The American Psychiatric Association in March reaffirmed its decades-old guidance that mental health professionals refrain from commenting on a person’s mental state without an evaluation and consent. Other medical professionals have criticized the rule as outdated and say it’s their civic duty to speak up when the most powerful person in the world appears unfit for office.

A spokesman for Northam says the lieutenant governor coined the phrase “narcissistic maniac” himself, drawing on both his medical training and his conversational way of speaking.

“It’s part-doctor, part-Eastern Shore,” said David Turner, Northam’s communications director.

Northam started calling Trump a maniac in speeches in front of Democratic activists in early March. Tom King, a consultant for Northam, said he took note of crowds “going nuts” at the line and then helped create the ad. On social media, reactions to the statement have ranged from along the lines of “he speaks the truth” to “he said WHAT?”

King acknowledged there was a potential for backlash from Democrats but says he hasn’t seen evidence of it harming the campaign. Northam is competing against former congressman Tom Perriello for the Democratic nomination in the June 13 primary.

“It says who Ralph is. He doesn’t say it in a mean way,” King said. “It’s not like it’s over the top.”

Northam leaned into his medical expertise when “Meet the Press” host Chuck Todd grilled him about the use of “narcissistic maniac” in an interview last week.

“Isn’t narcissism a technical term? Are you using the term the way your medical training would tell you?” Todd asked

“You know, I’m a pediatric neurologist, there’s a lot of overlap between psychiatry and neurology, and I would invite the viewers to look up the criteria for narcissism . . . ”

“You believe he meets the clinical — ” Todd interrupted.

“I think they’ll see some familiarity with what they’ll see,” Northam finished.

After the appearance, Northam tweeted “Yeah, I said it” above a GIF of him repeating the attention-grabbing line in his commercial.

Susan Goold, a bioethicist and medical professor at the University of Michigan, said physicians who are running for public office should avoid secondhand diagnoses. But she said Northam appears to be on solid footing because he’s encouraging voters to look up the disorder themselves and stopping short of a formal diagnosis.

“Could he be a little more careful? Sure,” Goold said. “Has he violated standards? No, not really.”

The “Goldwater Rule” for mental health professionals dates to 1973, after Republican presidential nominee Barry Goldwater successfully sued FACT magazine for defamation after publishing the results of a survey of psychiatrists assessing whether he was psychologically fit for the office.

But the Goldwater Rule doesn’t apply to physicians like Northam, experts said.

“A neurologist really can say whatever she wants about a public figure, hopefully not in a way that seems like she’s overstepping,” said Claire Pouncey, a Philadelphia psychiatrist who has studied and criticized the Goldwater Rule.

Another ethicist urged Northam to avoid the phrase, in the spirit of reducing stigma surrounding mental disorders and keeping politics out of medicine.

Trump “really seems to love himself; you don’t have to be a psychiatrist to see that. But to put a label on it is an easy way for politicians and psychiatrists, especially politicians who are health professionals, to gain a political advantage,” said Stuart J. Youngner, a psychiatrist and medical ethicist at Case Western Reserve University. “The use of psychiatry in politics has a long and very sad troubled history.”